Routine screening catches child abuse in ER

NEW YORK (Reuters Health) - Routinely screening all children seen in the ER for signs of maltreatment seems to have improved child abuse detection in the Netherlands, a new study finds.

The progress suggests that such systematic screening helps catch more cases of child abuse, researchers report in the journal Pediatrics.

But whether the findings could extend to other countries is unclear. And one emergency physician doubted the usefulness in U.S. hospitals.

It's estimated that about one in 30 children in the Netherlands are victims of abuse.

But compared with some other countries, Dutch ER staff have historically been less likely to pick up possible abuse, according to the researchers on the new study, led by Ida J. Korfage of the University Medical Center Rotterdam.

Child abuse is suspected in about 0.2 percent of Dutch children who end up in an ER -- versus 2 percent in Italy, up to 6 percent in the UK, and about 10 percent in the U.S.

So for the new study, Korfage and her colleagues created and tested a standard "checklist" that ER nurses could use to screen for possible child abuse. If a child met any of the checklist "warning signs," the nurse would tell the doctor, who then had the job of investigating further.

The researchers had four ERs adopt the checklist, and gave nurses there training in spotting possible child abuse. Three other hospitals served as a comparison group.

Then, in the middle of the study, the Netherlands passed a law requiring ERs to screen all children for potential child abuse. So over two years, all of the hospitals -- not just the ones given the checklist -- increased their screening rates.

And the screening seemed to boost the chances of catching abuse,

Of children who were screened at any ER, 0.5 percent were considered possible abuse victims. That compared with only 0.1 percent of kids who were not screened.

According to Korfage's team, the findings suggest that a combination of legal requirements and staff training boosts abuse screening rates - and that, in turn, improves child abuse detection. (Korfage did not respond to an email requesting comment.)

UNCLEAR EFFECT IN THE U.S.

"It's great that they found a way to improve child abuse detection, because detection was really low in the Netherlands," said Dr. Michael J. Gerardi, who directs pediatric emergency medicine at Goryeb Children's Hospital in Morristown, New Jersey, and serves on the board of the American College of Emergency Physicians.

"But I don't think this should be interpreted as suggesting it would work in the U.S.," Gerardi said.

In general, staff in U.S. ERs would start with the nature of the child's injuries; if they raised suspicions, the doctor would investigate further, including questioning the caregiver.

Gerardi said he does not believe a standard checklist, done for every child in the ER, is necessary. He thinks the checklist used in this study "raised awareness" of child abuse among Dutch ER staff who'd lacked it.

Child abuse detection is part of the "core curriculum" for emergency physicians in the U.S., Gerardi said. He pointed out that the staffing in Dutch ERs is different; that is, they are not emergency medicine specialists.

Half of the doctors working in ERs in this study were surgeons, while the rest were mostly pediatricians.

In the U.S., states require doctors to report suspected cases of abuse to local child protective services. But Gerardi said he did not think mandatory screening of all kids who arrive in the ER would be necessary or helpful.

"Do we catch all cases of child abuse? No. It's still a problem," Gerardi said.

But, he added, using a standardized checklist is no guarantee, either. "Your answer on the checklist could be wrong."

Gerardi put more stock in the promise of electronic medical records, which can be shared among providers. So even if an abused child with repeat injuries is brought to different hospitals each time, he said, doctors will be better able to "connect the dots."

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